Drug interactions
Artemether / lumefantrine + Nortriptyline
Severity: Major
Artemether / lumefantrine and Nortriptyline: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Artemether/lumefantrine can prolong the QT interval, as can nortriptyline, so combined use increases arrhythmia risk. Lumefantrine is also reported to inhibit CYP2D6, which may raise nortriptyline concentrations and add to cardiac and anticholinergic toxicity.
What this interaction means in plain words
Artemether / lumefantrine and Nortriptyline can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive QT prolongation plus CYP2D6 inhibition by lumefantrine, reducing nortriptyline clearance.
What to do
Avoid concurrent use if an alternative exists. If needed, obtain an ECG, correct electrolytes, monitor for tricyclic toxicity and consider reducing the nortriptyline dose.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Nortriptyline
- Disopyramide + Nortriptyline Contraindicated
- Dofetilide + Nortriptyline Contraindicated
- Dronedarone + Nortriptyline Contraindicated
- Ibutilide + Nortriptyline Contraindicated
- Isocarboxazid + Nortriptyline Contraindicated
- Methylene blue + Nortriptyline Contraindicated
Frequently asked questions
Can I take Artemether / lumefantrine with Nortriptyline?
MediHelp rates the interaction as major. Artemether / lumefantrine and Nortriptyline can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Artemether/lumefantrine can prolong the QT interval, as can nortriptyline, so combined use increases arrhythmia risk. Lumefantrine is also reported to inhibit CYP2D6, which may raise nortriptyline concentrations and add to cardiac and anticholinergic toxicity.
How serious is the interaction between Artemether / lumefantrine and Nortriptyline?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid concurrent use if an alternative exists. If needed, obtain an ECG, correct electrolytes, monitor for tricyclic toxicity and consider reducing the nortriptyline dose.
What other medicines interact with Nortriptyline?
MediHelp also lists interactions of Nortriptyline with, for example, Disopyramide, Dofetilide, Dronedarone. The full list is on the Nortriptyline page.
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